The Need for Urgent Colonoscopy for Critically Ⅲ Patients with Acute Lower Gastrointestinal Bleeding

緊急大腸鏡檢查對於極重症病患發生急性下消化道出血之治療之必要性

林俊哲(Chun-Che Lin) ； 何尉旗(Wei-Chi Ho) ； 陳丹霞(Tan-Hsia Chen) ； 陳滋彥(Tzy-Yen Chen) ； 林金坤(Chun-Ken Lin)

《中山醫學雜誌》 16卷2期 (2005/12) Pp. 261-271

https://doi.org/10.30096/CSMJ.200512.0007

摘要

目的：期待獲知於一所大學附設醫院暨醫學中心之內科因有合併症住院及加護病房內之極重症病患，急性下消化道出血之發生率、導致出血之主要病灶、以及出血後之臨床表現及影響，並探討影響癒後之因素及討論大腸鏡檢查之必要性。
方法：自2001年7月起至2004年6月止，計有5960名病患因病況危急而住進內科加護病房。其中有55名(0.92%)病患發生下消化道出血而須緊急進行床邊大腸鏡檢查。分別紀錄並分析病患之基本臨床生理數值、大腸鏡檢查診斷、及癒後分析。
結果：共有37名(67.3%)病患利用大腸鏡檢查發現出血病兆。病兆主要發生在左側大腸(78.4%)。最常見之出血病兆為炎性病兆（缺血性、感染性、及放射性）及直腸潰痬。整體住院中死亡率為52.7%(29/55)，而僅有兩名病患之死亡與出血有關。經多因子變項分析後僅有APACHE Ⅱ分數超過18者，為唯一獨立致死危險因子。
結論：因其他合併症而住院之病患，若是再發生急性下消化道出血，其出血的原因及出血後的臨床表徵，與單純只因嚴重下消化道出血而住院的病人相比，顯著有所不同，對於極重症病患需加護醫療的病息，若發生急性下消化道出血，大腸鏡檢查仍為一種安全且有效率之工具。然而病患原有之疾病嚴重度為影響其存活之唯一主要因素。

關鍵字

緊急大腸鏡 ； 下消化道出血 ； 重症病患 ； 加護病房

並列摘要

Purpose: To elucidate the frequency, the etiology, and the clinical impact of acute lower GI bleeding acquired by critically ill adults during their stay in the ICUs of a university-affiliated hospital.
Methods: From July 2000 to June 2003, 55 patients acquired lower GI bleeding during their stay in an ICU underwent urgent colonoscopy. We analyzed their baseline characteristics, data on the maneuver, and outcomes.
Results: The colonoscopy successfully identified the source of bleeding in most patients (67.3%), the most frequent being colitis (ischemic, infectious or non-specific), rectal ulcers, tumors and diverticular diseases. There were no serious adverse events related to colonoscopy. Although overall in-hospital mortality was 52.7%, hemorrhage-related deaths occurred in only 2 (3.6%) patients. Multivariate analysis found the only independent predictor of mortality to be an APACHE Ⅱ score＞18 (odds ratio=7.71; 95% confidence interval=2.03-29.25, p＜0.05).
Conclusions: Colonoscopy is safe and effective diagnostic procedure for these patients and the risk of death attributable to such bleeding is low. Overall severity of the underlying diseases, rather the urgent colonoscopy itself, may predict outcomes in this high-risk population.

並列關鍵字

urgent colonoscopy ； lower gastrointestinal hemorrhage ； critically ill ； intensive care unit